37 research outputs found
Palijativna skrb kao javnozdravstveni prioritet Bjelovarsko-bilogorske županije
MeÄu brojnim zdravstvenim prioritetima u Hrvatskoj palijativna skrb, odnosno briga za oboljele u zavrÅ”nom stadiju neizljeÄive bolesti, relativno je kasno prepoznata te joÅ” uvijek nisu uspostavljeni odgovarajuÄi institucionalni oblici takve skrbi unutar sustava javnog zdravstva. Upravo stoga Županijski tim za zdravlje BBŽ odluÄio je meÄu zdravstvene prioritete županije uvrstiti i prioritet poboljÅ”anja skrbi za one koji boluju od neizljeÄivih bolesti u svom zavrÅ”nom stadiju. NajÄeÅ”Äe se radi o oboljelima od zloÄudnih bolesti koje, nažalost, pogaÄaju sve uzraste pa i djecu, ali isto tako postoje i nemaligne kroniÄne bolesti progresivnog i fatalnog tijeka za koje nema drugih metoda lijeÄenja osim metoda palijativne medicine (npr. amiotrofiÄna lateralna skleroza)
Inervacijsko podruÄje glosofaringealnog živca kao ishodiÅ”te orofacijalne boli - dijagnostiÄki i terapijski izazov
Chronic neuropathic orofacial pain along with physical suffering can cause
emotional, psychological and social difficulties, which significantly affects the quality of life of patients.
Pain in the area of glossopharyngeal nerve innervation, especially chronic neuropathic, is relatively
rare, but is significant because of the great suffering it causes to sufferers. It can be life threatening,
due to the cardiac arrhythmia, syncope or convulsions it can cause. Drug treatment is often of limited
effectiveness and can be fraught with side effects. It is necessary to look for the etiology of the
underlying disease, and if possible, to take adequate causal treatment. This review article discusses the
etiology, clinical features, differential diagnosis, and treatment modalities of neuropathic pain in the
area of glossopharyngeal nerve innervation.KroniÄna neuropatska orofacijalna bol uz fiziÄku patnju može uzrokovati emocionalne, psihiÄke i socijalne poteÅ”koÄe,
Å”to znaÄajno utjeÄe na kvalitetu života bolesnika. Bol u inervacionom podruÄju glosofaringealnog živca, osobito kroniÄna
neuropatska, relativno je rijetka, ali je znaÄajna zbog velike patnje koju može uzrokovati oboljelima. Istodobno, može
biti životno ugrožavajuÄa, zbog srÄane aritmije, sinkope ili konvulzija koje može uzrokovati. Medikamentno lijeÄenje je
Äesto ograniÄene uÄinkovitosti i može biti optereÄeno nuspojavama. Neophodno je tragati za etiologijom poremeÄaja, te
po moguÄnosti poduzeti adekvatno kauzalno lijeÄenje. Ovaj pregledni Älanak govori o etiologiji, kliniÄkim znaÄajkama,
diferencijalnoj dijagnostici i modalitetima lijeÄenja kroniÄne neuropatske boli koja potjeÄe iz inervacionog podruÄja
glosofaringealnog živca
MoguÄnosti upravljanja materijalnim troÅ”kovima anestezije analizom razliÄitih anestezioloÅ”kih tehnika
The must of material cost rationalization in medical practice has stimulated the authors to analyze the structure of material expenses of spinal and general anesthesia on a model of arthroscopic knee surgery. The aim was to determine whether the cost of spinal anesthesia was still lower than that of general anesthesia after the introduction of expensive atraumatic needles. In addition, we were interested in the extent to which our daily practice correlated with that in industrialized countries and what were the possibilities of cost rationalization. Using retrograde analysis of two comparable groups of 40 patients each, submitted to arthroscopic knee surgery in general or spinal anesthesia, the anesthesia material expenses were divided into variable and constant expenses that are partially common to both types and partially specific for each type of anesthesia. The sums of variable and specific expenses were compared between the two types of anesthesia, amounting to 78,26 HRK for spinal anesthesia and 115,19 HRK for general anesthesia. There were no major operative or postoperative complications in either patient group. As only 40% of the procedures were performed in spinal anesthesia, whereas the respective figure in industrialized countries exceeds 70%, there is obviously much room for savings. If the percent of the procedures performed in spinal anesthesia were increased to the feasible 60%, a saving of 1470 HRK would be achieved exclusively in knee arthroscopy surgery, considering that some 200 procedures have been performed per year.Imperativ racionalizacije materijalne potroÅ”nje u medicinskoj praksi potaknuo je autore da na modelu artroskopske operacije koljena analiziraju strukturu materijalnih troÅ”kova spinalne i opÄe anestezije. Cilj je bio utvrditi je li spinalna anestezija i nakon uvoÄenja skupih atraumatskih igala i dalje jeftinija od opÄe anestezije. Zanimalo nas je kako naÅ”a dnevna praksa korelira s onom u razvijenim zemljama i koje su moguÄnosti racionalizacije. Retrogradnom analizom dviju usporedivih skupina od po 40 bolesnika artroskopiranih u opÄoj, odnosno spinalnoj anesteziji materijalni troÅ”kovi anestezije podijeljeni su na varijabilne i stalne, od kojih je dio univerzalan za obje anestezije, a dio specifiÄan za svaki tip anestezije. UsporeÄivane su sume varijabilnih i specifiÄnih troÅ”kova dvaju tipova anestezije koje za spinalnu anesteziju iznose 78,26 kn, a za opÄu 115,19 kn. Ni u jednoj skupini nisu zabilježene znaÄajne operacijske ili poslijeoperacijske komplikacije. Kako je od spomenutih operacija samo 40% operirano u spinalnoj anesteziji, dok je prosjek razvijenih zemalja iznad 70%, postoji dosta prostora za uÅ”tedu. Samo na artroskopijama koljena kojih se godiÅ”nje radi oko 200 uÅ”tedjelo bi se 1470 kn kad bismo postotak operiranih u spinalnoj anesteziji podigli na realno ostvarivih 60%
PAINFUL NEUROPATHY OF THE LINGUAL NERVE ā A CASE REPORT
Prikazan je sluÄaj Å”ezdesetdvogodiÅ”nje bolesnice s karakteristiÄnom kliniÄkom slikom kroniÄne neuropatske orofacijalne boli u inervacijskom podruÄju lingvalnog živca. Medicinska dokumentacija pokazuje da je bolesnica tijekom Å”estogodiÅ”njeg lijeÄenja uÄinila brojne kliniÄke preglede kao i laboratorijske, ultrazvuÄne, radioloÅ”ke, neuroradioloÅ”ke i endoskopske pretrage u cilju pronalaženja moguÄeg patoloÅ”kog procesa u podlozi neuropatske boli. Upotrebom razliÄitih analgetika i koanalgetika postignuta je tek djelomiÄna analgezija. Razlozi za to mogu se pripisati nedostatku dobre komunikacije s bolesnicom, nedostatku defi niranih lako primjenjivih dijagnostiÄkih kriterija i metoda, nedostatnoj edukaciji o boli u dodiplomskoj nastavi, te nedostatku analgetika i koanalgetika koji bi bili uÄinkovitiji, sigurniji i s manje nuspojava. JoÅ” jednu od znaÄajnih prepreka donosi i neusklaÄenost terapijskih algoritama i smjernica za propisivanje lijekova struÄnih druÅ”tava i propisa nacionalnog zavoda za zdravstveno osiguranje.In this paper, we present a case of a female 62-year-old patient with a characteristic clinical picture of chronic neuropathic orofacial pain in the lingual nerve innervation area. During six years of treatment, the patient had undergone numerous diagnostic tests, which were normal. By using different analgesics and co-analgesics, partial analgesia was achieved. The reasons for this could be the lack of appropriate communication with the patient, absence of validated and diagnostic criteria and methods easily applicable in clinical practice, insuffi cient education in pain management through undergraduate medical studies, as well as shortage in analgesics and co-analgesics that would be more effi cient, safer and with fewer side effects. Another major obstacle originates from the mismatch in therapeutic algorithms and prescribing guidelines favored by professional societies and those regulated by the National Institute of Health
QUALITY OF LIFE IN PATIENTS WITH CHRONIC NEUROPATHIC NONODONTOGENIC OROFACIAL PAIN
KroniÄna neuropatska neodontogena orofacijalna bol (OFP) vodeÄi je simptom Å”irokoga spektra bolesti, a može egzistirati i samostalno, bez drugih kliniÄkih znakova ili simptoma, uz uredne radioloÅ”ke ili laboratorijske nalaze. OFP može uzrokovati emocionalne, psiholoÅ”ke i socijalne poremeÄaje i tako znaÄajno utjecati na kvalitetu života oboljele osobe.
Cilj je istraživanja usporedba procijenjene, sa zdravljem povezane kvalitete života, i stupnja depresije ispitanika s OFP, s rezultatima zdravih ispitanika kontrolne skupine.
Ispitanici i metode: u studiju je ukljuÄeno 100 ispitanika prosjeÄne dobi 56,95(Ā±13,58), s kliniÄkom dijagnozom OFP, u trajanju od najmanje Å”est mjeseci, i 119 zdravih ispitanika prosjeÄne dobi 57,21(Ā±13,87), koji su bili kontrolna skupina. Primjenjen je standardni dijagnostiÄki protokol: 1) demografski podaci; 2) procjena nazoÄnosti neuropatske boli Leedskim upitnikom neuropatskih znakova i simptoma (LANSS); 3) odreÄivanje intenziteta boli vizualno analognom ljestvicom (VAS) u trenutku ispitivanja te tijekom protekloga mjeseca; 4) procjena emocionalnoga statusa Beckovim inventarom depresije II (BDI-II); 5) procjena o zdravlju ovisne kvalitete života SF-36 upitnikom.
Rezultati: prosjeÄan LANSS rezultat za skupinu oboljelih iznosi 17,18, a za kontrolnu skupinu 0. ProsjeÄan rezultat BDI-II u skupini oboljelih je 18,31, prema 5,87 u kontrolnoj skupini. Mann-Whitneyjevim U testom svaka od devet kategorija koje mjeri SF-36 statistiÄki se signifikantno razlikuje izmeÄu bolesnih i zdravih ispitanika. U svim kategorijama, osim jedne (vitalnost), kontrolna skupina ima viÅ”i indeks u odnosu na skupinu s OFP. Rezultat kontrolne skupine veÄi je od 60% u Å”est od devet kategorija, dok skupina oboljelih ne prelazi granicu od 60% niti u jednoj kategoriji.
ZakljuÄak: kroniÄna neuropatska neodontogena orofacijalna bol uzrokuje depresiju i utjeÄe na gotovo sve odrednice kvalitete života, mjerene SF-36 upitnikom. Postoji jaka povezanost izmeÄu depresije i niske kvalitete života oboljelih od OFP.Background: Chronic neuropathic nonodontogenic orofacial pain (OFP) is the leading symptom of a wide range of diseases, which can exist independently, without other clinical signs or symptoms and without abormalities in radiological or laboratory findings. OFP is a disease which should be treated adequately. Its successful treatment depends on the early diagnostics and understanding of the mechanisms of its occurrence. The most frequent clinical entity in our sample was nonodontogenic trigeminal neuralgia, the fifth cranial nerve disorder characterized by bouts of intense, sharp pain which usually affects one or two branches of the nerve on one side of the face. In most cases, the exact cause of trigeminal neuralgia has not been completely clarified. OFP causes emotional, psychological and social disorders, which can significantly affect the quality of life of the affected person.
Aim of study: The aim of the research is to compare the estimated health-related quality of life and the degree of depression of patients with OFP with healthy control subjects, using a validated Croatian version of the SF-36 Health Survey Questionnaire and the Beck Depression Inventory II.
Patients and Methods: The controlled cross-sectional study included 100 patients aged between 18 and 75, with the clinical diagnosis of OFP in duration of at least six months (72 females and 28 males), and 119 healthy subjects (73 females and 46 males) as a control group. A standardized diagnostic protocol was applied to both the patients and the control group: 1) demographic data and quantitative estimate of pain on the visual analog scale (VAS); 2) evaluation of presence of neuropathic pain measured by the Leeds Assessment of Neuropathic Signs and Symptoms (LANSS); 3) evaluation of emotional status using the Beck Depression Inventory II, and 4) assessment of health-related quality of life using the SF-36 Questionnaire. The KolmogorovāSmirnov Test analyzed the normality of data distribution, and, in keeping with the results, suitable nonparametric tests were used in further data processing. Quantitative data were shown through medians and interquartile range, while the nominal and categorical data were presented through absolute frequencies and the corresponding relative frequencies. The difference in the continued values between the groups
were analyzed using Mann-Whitney U Test, while the differences between the nominal and categorical values were analyzed using Chi-Square Test. Spearman's rank correlation coefficient between individual clinical parameters was calculated. All P values smaller than 0.05 were considered statistically significant.
Results: The average LANSS score for the patients was 17.18, and for the control group 0. The average BDI-II score for the patients was 18.31, as opposed to 5.87 for the control group. The Mann-Whitney U Test for each of the nine categories that measure SF-36, shows statistically significant difference between the affected and healthy subjects. In all the categories except one (Vitality), the control group has a higher index than the group with OFP. The result of the control group was equal or greater than 60% of the possible overall result in seven out of nine categories, while the treatment group did not exceed the limit of 60% in any of the categories. A statistically significant correlation was noted between the degree of depression and the SF-36 domains of Physical Functioning (PF), Body Pain (BP), General Health Perception (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). No statistically significant correlation was proven between the degree of depression and the domains of Role Physical (RP) and Health Transition (HT).
Conclusion: Chronic neuropathic nonodontogenic orofacial pain causes depression and affects almost all the determinants of quality of life measured by SF-36 Questionnaire. There is a strong correlation between depression and low quality of life in patients with OFP
COMPASSION AS THE ADDED VALUE OF HEALTH CARE
Tijekom posljednjih godina objavljen je veliki broj radova koji prouÄavaju uÄinke razliÄitih emocionalnih interakcija izmeÄu zdravstvenih djelatnika i bolesnika na ishode lijeÄenja, cijenu ukupne skrbi te uÄinke na same zaposlenike u zdravstvu. Interes za ovo podruÄje dijeli i Å”ira javnost zbog raÅ”irenog miÅ”ljenja kako se suvremena medicina suviÅ”e depersonalizirala i distancirala od emocionalne ukljuÄenosti i suosjeÄajnosti. Tako nastaje nova znanstvena disciplina ākompasionomikaā (engl. Compassionomic) koja prouÄava mehanizme djelovanja i uÄinke na ishod lijeÄenja suosjeÄajnog pristupa u zdravstvenoj skrbi. Istraživanja ukazuju da se pozitivni uÄinci na ishod bolesnika lijeÄenih u okruženju koje njeguje kulturu suosjeÄajnosti i brižnosti postižu veÄim stupnjem povjerenja, time snažnijom mobilizacijom neuro-endokrinih i imunoloÅ”kih mehanizama obrane te boljim pridržavanjem terapijskih preporuka. Time se poboljÅ”ava kvaliteta te istovremeno smanjuje cijena lijeÄenja. Pritom je važno defi nirati pojam suosjeÄajnosti (engl. Compassion) koji u ovom kontekstu znaÄi ne samo suosjeÄanje s patnjom (empatiju) veÄ i spremnost aktivnog Äinjenja da se pacijentu pomogne. Preliminarna istraživanja pokazuju da bolji ishod lijeÄenja kao rezultat veÄeg emocionalnog i struÄnog angažmana zdravstvenim djelatnicima dolazi kao nagrada koja im pruža ispunjenje i time ukupno manji stres izgaranja. Ovakav koncept u mnogome je joÅ” hipotetiÄan. MeÄutim, ako su pretpostavke o āmultiplicirajuÄemā pozitivnom uÄinku suosjeÄajnosti na sve zainteresirane strane zdravstvenog sustava toÄne, tada se nameÄe potreba kreiranja i provedbe odgovarajuÄih edukacijskih programa, kako bi se osnažio terapijski pristup koji ukljuÄuje aktivnu suosjeÄajnost. UÄinkovitost takvih programa može se mjeriti pomoÄu odgovarajuÄih alata koji mjere indikatore zadovoljstva pacijenata, zdravstvenih djelatnika i treÄeg sektora kao i indikatore ishoda lijeÄenja Äime ulazimo u podruÄje medicine utemeljene na dokazima. SuosjeÄajni pristup u lijeÄenju svoje mjesto ima u svakoj medicinskoj djelatnosti, kako kurativnoj tako i palijativnoj, jer u svojoj biti njeguje holistiÄki pristup s bolesnikom u srediÅ”tu, s punom druÅ”tvenom odgovornoÅ”Äu i visokim moralnim i etiÄkim standardima struke.In the past few years, there were many papers in the biomedical literature studying the effects of various emotional interactions between healthcare professionals and patients regarding treatment outcomes, total cost of care and effects on healthcare workers themselves. The interest in this area is also shared by the wider public because of the widespread belief that modern medicine has become depersonalized and distant from emotional involvement and compassion. Today, there is considerable evidence from relevant research suggesting that compassionate care brings additional value to therapeutic procedures. The study of these benefi ts, their mechanisms of action and effects on treatment outcome, as well as on healthcare providers is called ācompassionomicsā. Compassion in this context means not only emotional response to the otherās suffering, but also the willingness to help the patient. By contrast, the term empathy, often used as a synonym of the concept of compassion, refers only to understanding and being affected with the otherās suffering. Positive effects on the outcome of patients treated in an environment that fosters a culture of compassionate care are likely to be achieved through a greater degree of trust between physicians and other healthcare professionals and patients, resulting in stronger mobilization of neuroendocrine and immune defense mechanisms that can contribute to healing or alleviating the symptoms of the disease. Better compliance to therapeutic recommendations has also been noted. These favorable effects are also refl ected in reducing the length of hospital stay and frequency of readmission, thus reducing the cost of treatment. Although it may seem that relationship to patients involving more emotion and compassion would lead healthcare workers faster to burnout syndrome, preliminary research suggests the opposite. It is interpreted by the fact that better outcome of treatment as a result of the more emotional and professional involvement of healthcare professionals comes as a reward
that provides fulfi llment of their human and professional mission and thus ultimately causes less pronounced burnout syndrome. All of this is the backbone of the theory of āmultiplyingā the positive effect of compassion on all stakeholders in healthcare. If this theory is correct, then there is the need for creation and implementation of appropriate educational programs through which a therapeutic approach based on the culture of active and effective compassion will be designed. The effectiveness of such programs can be measured by appropriate tools that measure patient satisfaction, satisfaction of healthcare professionals and other interested parties. More objective indicators can be obtained by measuring the outcome of treatment, thus entering the sphere of the evidence-based medicine. In many aspects, this concept is still hypothetical and based in particular on observational studies. Compassionomics strives to make this area a subject of serious scientific expertise in which it is increasingly successful. Active compassion has its place in every medical activity, both curative and palliative, because it cares for the holistic approach with the patient in the center, with full social responsibility and high moral and ethical standards of profession. Since all healthcare systems, including ours, are constantly in the midst of increased needs and limited resources, the understanding of the multiple positive effects of compassion offers new hope for rationalization and sustainability of the healthcare system and its further development in the direction of increasing humanity
QUALITY OF LIFE IN PATIENTS WITH CHRONIC NEUROPATHIC NONODONTOGENIC OROFACIAL PAIN
KroniÄna neuropatska neodontogena orofacijalna bol (OFP) vodeÄi je simptom Å”irokoga spektra bolesti, a može egzistirati i samostalno, bez drugih kliniÄkih znakova ili simptoma, uz uredne radioloÅ”ke ili laboratorijske nalaze. OFP može uzrokovati emocionalne, psiholoÅ”ke i socijalne poremeÄaje i tako znaÄajno utjecati na kvalitetu života oboljele osobe.
Cilj je istraživanja usporedba procijenjene, sa zdravljem povezane kvalitete života, i stupnja depresije ispitanika s OFP, s rezultatima zdravih ispitanika kontrolne skupine.
Ispitanici i metode: u studiju je ukljuÄeno 100 ispitanika prosjeÄne dobi 56,95(Ā±13,58), s kliniÄkom dijagnozom OFP, u trajanju od najmanje Å”est mjeseci, i 119 zdravih ispitanika prosjeÄne dobi 57,21(Ā±13,87), koji su bili kontrolna skupina. Primjenjen je standardni dijagnostiÄki protokol: 1) demografski podaci; 2) procjena nazoÄnosti neuropatske boli Leedskim upitnikom neuropatskih znakova i simptoma (LANSS); 3) odreÄivanje intenziteta boli vizualno analognom ljestvicom (VAS) u trenutku ispitivanja te tijekom protekloga mjeseca; 4) procjena emocionalnoga statusa Beckovim inventarom depresije II (BDI-II); 5) procjena o zdravlju ovisne kvalitete života SF-36 upitnikom.
Rezultati: prosjeÄan LANSS rezultat za skupinu oboljelih iznosi 17,18, a za kontrolnu skupinu 0. ProsjeÄan rezultat BDI-II u skupini oboljelih je 18,31, prema 5,87 u kontrolnoj skupini. Mann-Whitneyjevim U testom svaka od devet kategorija koje mjeri SF-36 statistiÄki se signifikantno razlikuje izmeÄu bolesnih i zdravih ispitanika. U svim kategorijama, osim jedne (vitalnost), kontrolna skupina ima viÅ”i indeks u odnosu na skupinu s OFP. Rezultat kontrolne skupine veÄi je od 60% u Å”est od devet kategorija, dok skupina oboljelih ne prelazi granicu od 60% niti u jednoj kategoriji.
ZakljuÄak: kroniÄna neuropatska neodontogena orofacijalna bol uzrokuje depresiju i utjeÄe na gotovo sve odrednice kvalitete života, mjerene SF-36 upitnikom. Postoji jaka povezanost izmeÄu depresije i niske kvalitete života oboljelih od OFP.Background: Chronic neuropathic nonodontogenic orofacial pain (OFP) is the leading symptom of a wide range of diseases, which can exist independently, without other clinical signs or symptoms and without abormalities in radiological or laboratory findings. OFP is a disease which should be treated adequately. Its successful treatment depends on the early diagnostics and understanding of the mechanisms of its occurrence. The most frequent clinical entity in our sample was nonodontogenic trigeminal neuralgia, the fifth cranial nerve disorder characterized by bouts of intense, sharp pain which usually affects one or two branches of the nerve on one side of the face. In most cases, the exact cause of trigeminal neuralgia has not been completely clarified. OFP causes emotional, psychological and social disorders, which can significantly affect the quality of life of the affected person.
Aim of study: The aim of the research is to compare the estimated health-related quality of life and the degree of depression of patients with OFP with healthy control subjects, using a validated Croatian version of the SF-36 Health Survey Questionnaire and the Beck Depression Inventory II.
Patients and Methods: The controlled cross-sectional study included 100 patients aged between 18 and 75, with the clinical diagnosis of OFP in duration of at least six months (72 females and 28 males), and 119 healthy subjects (73 females and 46 males) as a control group. A standardized diagnostic protocol was applied to both the patients and the control group: 1) demographic data and quantitative estimate of pain on the visual analog scale (VAS); 2) evaluation of presence of neuropathic pain measured by the Leeds Assessment of Neuropathic Signs and Symptoms (LANSS); 3) evaluation of emotional status using the Beck Depression Inventory II, and 4) assessment of health-related quality of life using the SF-36 Questionnaire. The KolmogorovāSmirnov Test analyzed the normality of data distribution, and, in keeping with the results, suitable nonparametric tests were used in further data processing. Quantitative data were shown through medians and interquartile range, while the nominal and categorical data were presented through absolute frequencies and the corresponding relative frequencies. The difference in the continued values between the groups
were analyzed using Mann-Whitney U Test, while the differences between the nominal and categorical values were analyzed using Chi-Square Test. Spearman's rank correlation coefficient between individual clinical parameters was calculated. All P values smaller than 0.05 were considered statistically significant.
Results: The average LANSS score for the patients was 17.18, and for the control group 0. The average BDI-II score for the patients was 18.31, as opposed to 5.87 for the control group. The Mann-Whitney U Test for each of the nine categories that measure SF-36, shows statistically significant difference between the affected and healthy subjects. In all the categories except one (Vitality), the control group has a higher index than the group with OFP. The result of the control group was equal or greater than 60% of the possible overall result in seven out of nine categories, while the treatment group did not exceed the limit of 60% in any of the categories. A statistically significant correlation was noted between the degree of depression and the SF-36 domains of Physical Functioning (PF), Body Pain (BP), General Health Perception (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). No statistically significant correlation was proven between the degree of depression and the domains of Role Physical (RP) and Health Transition (HT).
Conclusion: Chronic neuropathic nonodontogenic orofacial pain causes depression and affects almost all the determinants of quality of life measured by SF-36 Questionnaire. There is a strong correlation between depression and low quality of life in patients with OFP